Techniques in Hand and Upper Extremity Surgery最新文献

There are several common types of fixations for metacarpal fractures: pins, plates, lag, and intramedullary (IM) screws. The advantages of pins are that they are ubiquitous, cost-effective, have shorter operative times, and preserve soft tissues, thereby minimizing adhesions. In this article, we describe metacarpal fracture fixation utilizing the technique of retrograde IM pinning through collateral recess access. We present the postoperative outcomes of our patients who underwent metacarpal fracture fixation utilizing this technique. Details of the fractures, patient comorbidities, demographics, and postoperative outcomes were gathered. Primary outcomes investigated were nonunion, malunion, need for revision, and range of motion (ROM). A total of 29 fractures in 14 patients were included, with multiple fractures present in 8 patients. The fractures were open in 8 cases. The orientation of the fracture was transverse in 22 cases and oblique in 7 with comminution noted in 13 fractures. Full ROM was obtained in 15 digits with 6 digits noted to have a good ROM and 6 digits still undergoing therapy. There were no nonunions noted and only one malunion. In conclusion, retrograde, double IM pinning through collateral recess access represents a reliable, cost-effective, and minimally traumatic method of metacarpal fixation, including carpometacarpal fracture dislocations.

Chronic exertional compartment syndrome (CECS) of the forearm is a rare but increasingly well-recognized condition that affects athletes and labor workers performing repetitive isometric loading of forearm musculature. There is no current consensus on surgical management for CECS of the forearm, and there is a paucity of literature to support a single technique. We describe the surgical management of CECS of the forearm with endoscopic forearm fasciotomy. This technique facilitates compartment-specific fasciotomy in patients diagnosed with CECS based on pre-operative intracompartmental pressure measurements while minimizing risks associated with wide-open and mini-open fasciotomy techniques. We demonstrate a step-by-step surgical approach for the treatment of this condition and provide an accompanying video demonstrating this surgical technique on a 20-year-old male collegiate rower with CECS of the bilateral forearms.

Nerve transfers, nerve grafts, and tendon transfers have been used to restore shoulder active external rotation in patients with brachial plexus birth injuries. Traditionally used nerve surgery techniques are nerve transfer from the spinal accessory nerve to a suprascapular nerve (SSN) or nerve grafting from C5 to the SSN. However, results are often suboptimal. A more distal and more targeted transfer from the spinal accessory nerve directly to the infraspinatus branch of the SSN has previously been described and mid-term outcomes are encouraging. Herein, we describe a modification of this technique with accompanying step-by-step intraoperative photographs.

Radial longitudinal deficiency III and IV present as a short upper limb, functional elbow, and wrist with severe radial and palmar angulation, where the carpus articulates with the radial and palmar edge of the ulna, allowing limited mobility in a nonfunctional position. Surgical treatment aims to correct radial angulation and flexed carpal position, often altering carpal positioning over the distal ulna and impacting wrist mobility. In addition, fixation through distal ulnar epiphysis affects its growth. Although these procedures improve appearance, functionality remains suboptimal. This study describes a novel ulnar osteotomy and extensor carpi ulnaris transfer for the correction of wrist deformity in radial longitudinal deficiency with preservation of ulnocarpal motion and epiphyseal growth. The surgical technique, indications, contraindications, and potential complications are described. Three cases with postoperative follow-ups at 36, 12, and 6 months, evaluating deformity and pre/postsurgical wrist mobility ranges, are reported. A correction was achieved in the forearm-hand angle of 71 to 88 degrees of the initial. The total range of movement, between 50 degrees and 80 degrees, was almost the same before and after the operation in the most anatomic position. In one patient, there was a residual deformity at the dorsoradial border, which showed no progression during the last 6 months of follow-up. For patients with radial longitudinal deficiency, functional outcomes with preserved mobility appear to hold greater significance. The technique described in this study enabled deformity correction while maintaining a wide range of motion. The preservation of the physis in a different orientation is an aspect that will need evaluation in long-term follow-up but offers potential treatment options in the future; due to the unknown of the secondary deformity, it is recommended that the long-term results should be awaited before adoption of this technique.

Serial physical examination is often required in the evaluation of brachial plexus injuries. (Noland, 2019) A comprehensive evaluation that includes a thorough history, electrodiagnostic evaluation, and imaging studies, in addition to physical examination, can provide valuable information about the location of the lesion, prognosis for recovery, and whether surgical intervention is necessary. After brachial plexus reconstruction, physical examinations are also performed to document clinical improvement and identify any residual issues. The videos included in this clinical examination techniques section demonstrate the muscle strength examination testing for the brachial plexus and offer best practices for documentation.

The KliniTray "breast board" used by many oncological breast surgeons is an innovative idea to succor microsurgical digital replantation. This piece of sterile equipment is readily available and provides excellent immobilization and retraction of the skin of digital amputates with minimal trauma. The fine metal pins are the key to its efficacy. They provide the flexibility to alter the position of the amputated part and alter the retraction of skin edges as many times as necessary. The construct acts as a tremor-free assistant for a single surgeon to efficiently prepare the amputated part of a digit, saving time including expensive theatre time.

Incision of the dorsal side of the tendon sheath in release of De Quervain's tenosynovitis has traditionally been advocated to prevent the risk of volar tendon subluxation. We describe a novel technique of complete excision, rather than simple incision, of the first dorsal compartment tendon sheath. Over a 10-year period, 147 patients (154 wrists) underwent first dorsal compartment release using this technique of complete excision of the sheath. No postoperative immobilization is used. Patients were followed for a mean of 7.0 months. Records were assessed for any complications including reoperation, tendon subluxation, recurrence, wound complications, scar tenderness, and superficial radial sensory nerve paresthesias. There were no cases of recurrence, reoperation, or tendon subluxation after release with this technique. Postoperatively, 7 (4.5%) patients had scar tenderness and 5 (3.2%) of these patients also had superficial radial sensory nerve parasthesias, which all resolved at the time of final follow-up. Mean range of motion was 73±11 degrees of flexion and 69±10 degrees of extension. In contrast to simple incision, we propose that this technique provides a more complete release of the compartment without risk of symptomatic subluxation or bowstringing and provides a complete release of a separate extensor pollicis brevis subsheath or any concomitant retinacular cysts associated with the tendonitis. There is an immediate removal of the symptomatic swelling and visible, painful bump associated with the thickened retinaculum with this technique. Furthermore, no immobilization is required after surgery.

Restoration of elbow flexion is a priority in treating adult traumatic brachial plexus injuries. A tendon transfer is an ideal option for patients not candidates for reconstructive nerve surgery or free-functioning muscle transfer. For patients with a partial brachial plexus injury or a pan plexus injury with adequate recovered triceps function and loss of elbow flexion, a triceps-to-biceps tendon transfer is a nonmicrosurgical option to restore elbow flexion. The technique of triceps-to-biceps transfer in which the complete triceps tendon is transferred laterally, secured lateral to the radial tuberosity, and reinforced with suture to the biceps tendon is described.